Foreskin EthicsIsabel Freire
Chair of the Sexual Rights Committee of The World Association for Sexual Health; Chair of the Ethical Committee of the Nordic Association for Clinical Sexology; Chair of the Committee on Sexual Ethics of the Finnish Association for Sexology. Activist to advance positive, open and liberal culture towards sexuality and diversity in society. Major interests: philosophical sexual ethics, professional ethics, philosophy of law, human & sexual rights and sexual politics.
28th February 2019
The circumcision of boys is often deemed as ”a difficult issue”. The difficulties mentioned frequently are gaps in legislation, lack of information, and dealing with different cultures and religions. Many difficulties tend to boil down to the dilemma between physical integrity of the child and freedom of religion or cultural rights of the parents. Without ethical competence, the terrain might seem impassable, and quite often it is used as an excuse to avoid the issue entirely. Fortunately there are powerful means of solving the difficulties. Actually, the circumcision of boys is rather easy question from the perspective of philosophical ethics. When it is discussed from the perspectives of fundamental interests and justification of actions, the difficulties begin to lose their potency.
Respect for the integrity of one’s body is one of the most fundamental claims an individual has towards others. No ethical tradition approves of violating it without very strong justification, especially when the case at hand is about violating the body of a child. Strong justifications could include pressing and immediate medical reasons or self-defence in extreme conditions. Reasons concerning culture, religion or everyday parenting are far from such special circumstances.
The most influential tradition in ethics is ethical liberalism. It is the spinal structure supporting human rights, civil liberties and constitutional democracies. Some central principles in the liberal tradition are the harm principle, that prohibits harming of others, and consent as justification for any activities affecting other people directly. Both principles protect essential interests of the individual: freedom and integrity.
The harm principle or its equivalent can be found from almost all traditions of ethics in different forms. The same idea has been presented as 1) the right to life, security and/or integrity, 2) the duty to respect other person as a subject or as an end itself, not just an instrument, or 3) the rule of benevolence or care. Even if there are some slight differences in different traditions, there is no ethical tradition, where it would be acceptable to mutilate a defenceless, innocent person.
[…] ethical principles should always be the same for everyone, and they should be applied in any situation. […] The values, culture, or religion of the parents are no exceptions to ethical principles. Even if the child is dependent on the parents or guardians, they have no right to infringe on the child’s fundamental interests
In ethical liberalism, harming is defined as setting back someone’s interests wrongfully. Bodily integrity, including keeping one’s body parts intact, is one of the most important interests to most living creatures. If the respect for bodily integrity eroded severely, no one would be safe from physical violence anymore. A child has the same interests as anyone what comes to keeping one’s body parts intact. A child feels pain acutely, and tries to avoid things that would hurt their body, just like any living creature would. To have such interests does not require the ability to express them verbally or to claim them personally.
In the case of circumcision of boys, the harm principle cannot be ignored by doing the operation medically properly with sterile instruments or anesthesia. The removal of foreskin violates the basic interest of intact body permanently, which cannot be redeemed by conducting the violation by following medical standards. If it could, then it would be acceptable to cut the ears off of your annoying neighbour, as long as the operation was done medically properly. If this sounds absurd, it is because it is absurd. The absurdity shows that grave violations of bodily integrity cannot be ignored just by doing the violation properly medically. From the ethical perspective, carefully done violation is not a bit better than carelessly done violation.
A sound ethical system is required to be universal. It means that ethical principles should always be the same for everyone, and they should be applied in any situation. Thus the harm principle binds and applies to adults, children and one’s own children equally. The values, culture, or religion of the parents are no exceptions to ethical principles. Even if the child is dependent on the parents or guardians, they have no right to infringe on the child’s fundamental interests. Life, integrity and wellbeing of the child are not for the parents to compromise, not even when the parents’ religion or culture would require foot binding, flagellation, cutting of ears, or genital mutilation.
Sometimes pro-circumcision groups claim that no ethical tradition nor declaration of rights prohibits the circumcision of boys specifically. This is true, because ethical argumentation aiming at universal principles does not work with lists of banned things. It works with principles that are then applied to particular situations. Harm principle is an universal rule, which is logically applied to create policies and laws to regulate particular instances. In the case of circumcision of boys, the application is simple: cutting of body parts of a defenceless, innocent child is harming and violation of the fundamental and vital interests of the child.
In the case of circumcision of boys, the harm principle cannot be ignored by doing the operation medically properly with sterile instruments or anesthesia
Freedom of religion or cultural rights cannot justify any infringements on the fundamental interests of a child, because rights belong always to the individual. Thus the freedom of religion would only grant a father the right to circumcise himself, not his child. The child has their own individual rights, which protect their body, autonomy and also freedom of religion, if the child would choose some other world-view than their parents, when they are older.
The wrongness of circumcision of boys does not mean that the procedure itself is wrong in all circumstances. The reason for wrongness lies in the violation of fundamental interests without valid justification. An adult may give justification for circumcision by consenting, because an adult may negotiate their boundaries and interests. In other words, adults have full control of their bodies and may allow many things to be done to them. If an adult chooses to circumcise themself, it will be ethically acceptable, because their consent is strong justification for the procedure even if it causes damage to their body.
It is clear that a small child is not able to give valid consent to cutting a body part off. Small children don’t even have the basic capabilities to express consent of any kind. Even if a child could speak and understand some basics about circumcision, their consent would not be valid, because it wouldn’t be informed enough about the functions and meanings of the foreskin in adult sexuality. A teenager, who has started solo sex and maybe other sexual activities, might have a better, informed understanding, but even then they are vulnerable to pressure exerted by their parents and kin.
Cultural and religious oppression towards dissidents, say a teenager choosing not to lose their foreskin for their parents’ religion, plays an important role, which cannot be ignored in assessing the validity of consent of minors. In tight-knit cultural or religious communities manipulation and pressure, even coercion, may be hard towards a teenager, who is expected to make ”the right decision” according to the tradition. Because the procedure is permanent and harmful, with risks and ill-effects involved, the validity of consent of a teenager should be assessed with extra sensitivity. The protection of the young person is always a priority.
Even if a child could speak and understand some basics about circumcision, their consent would not be valid, because it wouldn’t be informed enough about the functions and meanings of the foreskin in adult sexuality. A teenager, who has started solo sex and maybe other sexual activities, might have a better, informed understanding, but even then they are vulnerable to pressure exerted by their parents and kin
Because of such deliberations, it is reasonable to claim that no circumcision should be done to minors, even if they seem to give consent to the procedure. It is reasonable to protect teenagers from the pressure by setting a clear age-limit. It is not a big infringement on the autonomy of the teenager to postpone the decision for a few years compared to the permanent harm, if the violation happens under pressure. For these reasons the specialists and child-protection officials in the Nordic countries have established a consensus on the age limit of 18 for any non-necessary genital alterations regardless of gender.
Medical emergencies might also provide some justifications for genital surgery done to a child. For clarity, such procedures should not be called circumcisions, which are mostly done for cultural, religious or cosmetic reasons. Foreskin surgery or removal can be justified by medical assessment, when the operation is necessary to treat an acute and persistent infection for example. The rights of the patient in the EU are clear about the prohibition of removal of healthy tissue without valid consent of the patient, unless there a vitally important and immediate reasons to do so. It is extremely rare to end up in such an emergency concerning the foreskin; most of infections or conditions, like phimosis, can nowadays be treated successfullysuccesfully without surgery.
To conclude, any genital procedures done to children must be justified with serious medical reasons. Without such justification the procedures are simply wrong, and they should be called mutilation or abuse instead of misleading terms like circumcision. To conclude that they are wrong, there is no need for long lists of evidence about physiological or sexological harm, but just the fact that violation of bodily integrity of a child is enough for ethical judgement. Genital mutilation of all kind is simply wrong regardless of the gender of the child.
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